Time to move on from counsel of gloom on personality disorder management

HW Griffiths' description of psychopathic disorder (Letters, 12 November) is clinically pessimistic, which is probably why he thinks it is untreatable. Judging from Dr Griffiths' approval of the Butler committee's report he would prefer this disorder banged up so he can concentrate on the really treatable illnesses, like schizophrenia and manic depression. His assumption is that if psychiatrists can't fix it, no one can - which may say more about the state of psychiatry than it does about psychopathic disorder.

Most psychiatrists may view this disorder as untreatable, but the profession does not speak with one voice. Some (mainly forensic) psychiatrists provide effective long-term treatment, but many of their colleagues state categorically that the only place for this disorder is prison. Some prescribe anti-psychotic medication to these 'patients' on an outpatient basis, as in the case of Michael Stone, while others state that medication has no place in their treatment. The result is that people like Michael Stone find themselves left in a conceptual wasteland. As (psychiatrist) Professor Peter Tyrer wrote in Personality Disorder Reviewed, 'Whatever the outcome, patients with personality disorders are important consumers of health services, particularly in the emergency and forensic settings. They also present rather more difficult problems in management than most other mental disorders, yet this should hardly be a reason for abandoning them.'

Quite. So we have two options. One is to give up entirely and allow the 'human condition' to do what it likes (when not in prison). The other is to give all the necessary legal and purchasing powers to psychologists and psychotherapists to lead a new and properly resourced service for these disorders. This would give clinicians opportunity to intervene early in childhood and adolescence, so the cycle of damage and waste can be broken before it is too late. Young people exhibiting conduct or behavioural disorders are regularly refused treatment by adolescent psychiatric units because they do not have a functional mental illness.

Too often at the Zito Trust we hear from families who have been told that nothing can be done for psychopathic personality disorder or, even worse, that 'nothing can be done until something happens'. Surely we can move on from this counsel of gloom and despondency to a radically innovative reconfiguration of the way these services are provided?

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